This document provides information on the 5 major childhood killer diseases (CB-IMNCI) in Nepal: pneumonia, diarrhea, measles, malaria, and malnutrition. For each disease, it lists signs, classifications, and recommended treatments according to CB-IMNCI guidelines. It describes pneumonia classifications and treatments for severe, pneumonia, and no pneumonia. For diarrhea, it outlines classifications and treatments for severe dehydration, some dehydration, no dehydration, dysentery, and persistent diarrhea. For measles, malaria, and malnutrition, it lists signs, classifications, and corresponding recommended treatments. The document aims to help participants understand and properly treat the 5 major childhood diseases according to CB-IMNCI standards.

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2. CB-IMNCI
5 major childhood
killer diseases Presenter:
Nisha Thapa
Nita Shrestha
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3. General Objective
■ At the end of session, participants will be able to know about the childhood 5
major killer disease (CB-IMNCI).
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Specific Objectives
At the end of session, participants must be able to:
■ enlist 5 major childhood killer disease.
■ define all 5 killer disease.
■ classify according to CB-IMNCI.
■ describe treatment according to CB-IMNCI.

4. PNEUMONIA
■ Pneumonia is an acute inflammation of lungs parenchyma that
impairs gas exchange.
■ It is the leading cause of mortality in children below 5yrs of age.
Child’s age Fast respiration rate
• 0 to 2 months 60 or more breaths per minute
• 2 months to 12months 50 or more breaths per minute
• 12months to 5years 40 or more breaths per minute
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5. SIGNS CLASSIFICATION TREATMENT
• Any general danger signs
OR,
• Stridor in calm child
Severe Pneumonia
OR,
very severe disease
• Give DIAZEPAM if
convulsion
• Rapid assessment
• Provide pre referral
treatment
• Give first dose of
appropriate antibiotic.
• Prevent or Treat for low
blood sugar.
• Keep child warm and
REFER urgently.
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6. SIGNS CLASSIFICATION TREATMENT
• Chest indrawing
OR,
• Fast breathing
Pneumonia • AMOXICILLIN twice a day
for 5days.
• If wheezing, give
BRONCHODILATOR by
inhaler or nebulizer.
• Oral SALBUTAMOL thrice
a day for 5days
• If suspected HIV or
infection, give first dose
of Amoxicillin then
REFER.
• If cough is persistent for
more than 14days,
REFER
• Soothe the throat and
relieve cough
• Counsel when to return
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7. SIGNS CLASSIFICATION TREATMENT
• No signs of pneumonia
or very severe disease
No pneumonia: Cough or
cold
• If wheezing, give
SALBUTAMOL 3 times a
day for 5days.
• If cough is persistent for
more than 14 days,
refer for further
assessment.
• Soothe the throat and
relieve cough.
• Counsel for when to
return immediately.
• Follow up in 5days if not
improving.
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8. DIARRHOEA
■ Diarrhoea is condition in which there is unusual frequent passage
of loose stool, 3 or more times in 24hrs.
■ Diarrhoea for less than 14days is called Acute Diarrhoea.
■ Diarrhoea for 14days or more is called Persistent Diarrhoea.
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9. SIGNS CLASSIFICATION TREATMENT
Two of the following signs:
• Lethargic or unconscious.
• Sunken eyes.
• Unable to drink or drink
slowly.
• Skin pinch goes back very
slowly.
Severe dehydration • If no other severe
classification then,
• Treat with ORS
according to
treatment plan ‘C’
OR,
• If other severe
classification then
• REFER urgently along
with ORS and
frequent breast
feeding.
• Give appropriate
antibiotic for child more
than 2yrs and if from
chlorea risk area.
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10. SIGNS CLASSIFICATION TREATMENT
Two of the following signs:
• Restless, irritable
• Sunken eyes
• Drinks eagerly
• Skin pinch goes back
slowly.
Some dehydration • Give fluids, Zinc and food
according to treatment
plan ‘B’.
• If other severe
classification then,
REFER urgently along
with ORS and frequent
breast feeding.
• Counsel caregiver when
to return immediately.
• If no improvement
,follow up in 5days for
evaluation.
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11. SIGNS CLASSIFICATION TREATMENT
• No signs of dehydration No dehydration • Give fluids, Zinc and food
according to treatment
plan ‘A’ at home
• Counsel caregiver when
to return immediately.
• If no improvement ,follow
up in 5days for
evaluation.
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12. SIGNS CLASSIFICATION TREATMENT
• Severe OR some
dehydration signs
Severe Persistent
Diarrhoea
• If no other severe
classification, treat
dehydration then REFER
• If other severe
classification, REFER
urgently with ORS and
breastfeeding
• Give single dose of
Vitamin A
• If mouth sores or severe
pneumonia or severe
disease or very low
weight, assess for HIV
and manage accordingly
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13. SIGNS CLASSIFICATION TREATMENT
• No signs of dehydration Persistent Diarrhoea • Advise on continue
feeding
• Single dose of Vitamin
A
• Give Zinc for 10days
• Follow up in 5 days
• If mouth sores or severe
pneumonia or severe
disease or very low
weight, assess for HIV
and manage
accordingly
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14. SIGNS CLASSIFICATION TREATMENT
• Blood in stool Dysentery • Treat for 3days with
CIPROFLOXACIN for
Shigella
• Give Zinc tab for 10days
in any type of diarrhoea
• Follow up in 3days
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15. MEASLES
■ Measles is a communicable disease caused by a RNA virus
belonging to Paramyxo virus family and characterized by fever,
cough, coryza, lacrimation, koplik spots in the pre-eruptive phase
and maculopapular rash starting on 4th or 5th day of illness.
■ Children from 6months to 2years are mostly affected.
■ Measles affect the epithelial tissue of lungs, intestine, stomach,
eyes, mouth and throat and decreases the immune system
making the child more susceptible to other infections.
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16. SIGNS CLASSIFICATION TREATMENT
• Any general danger sign
OR,
• Pneumonia OR,
• Symptomatic HIV
infection OR,
• Clouding of cornea OR,
• Deep or extensive mouth
ulcers
Suspected Complicated
measles
• Give additional dose of
Vitamin A
• If clouding of the cornea
or pus draining from the
eye, apply
CHLORAMPHENICOL eye
oint.
• Give first dose of
AMOXICILLIN unless child
is receiving IM
CEFTRIAXONE for another
reason.
• REFER urgently.
• Immunize all close
contacts over 6mths of
age within 72hrs of
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17. SIGNS CLASSIFICATION TREATMENT
• Measles symptoms
present and,
• Measles test positive.
Measles • Give additional dose of
vit. A
• If pus draining from eye,
treat eye infection with
CHLORAMPHENICOL eye
oint for 7days.
• If mouth ulcer, treat with
CHLORHEXIDINE.
• Notify EPI coordinator,
and complete necessary
forms.
• Isolate the child from
other children for 5 days
• Immunize all close
contacts over 6mths of
age within 72hrs of
exposure.
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18. SIGNS CLASSIFICATION TREATMENT
• Measles test results not
available and
• Measles symptoms
present
Suspected measles • Give additional dose of
vitamin A
• Notify EPI coordinator,
and complete necessary
forms.
• Take specimens as
advised by EPI
coordinator, and send
these to the NICD.
• Isolate the child from
other children for 5 days
• Immunize all close
contacts over 6mths of
age within 72hrs of
exposure.
• Follow up in 2days
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19. MALARIA
■ malaria is a life threatening disease caused by Plasmodium
parasites that are transmitted to people through the bites of
infected female Anopheles mosquitoes.
■ Among the other species, Plasmodium falciparum is of greatest
threat that cause child mortality.
■ If left untreated, malaria fever can progress to severe complicated
malaria and even death within 24hrs of period.
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20. HIGH/LOW- MALARIA RISK area
SIGNS CLASSIFICATION TREATMENT
• Any general danger sign,
OR,
• Stiff neck
OR,
• Any Danger sign with
Microscopic /RDT positive
Severe complicated
malaria or high grade fever
• Prepare a blood smear in
a slide . Give single dose
of RECTAL ARTISUNATE
then refer along with
slide.
• Give first dose of
appropriate antibiotic.
• Test and treat or prevent
low blood sugar
• Give one dose of
PARACETAMOL for fever
38degree celcius or
above .
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21. SIGNS CLASSIFICATION TREATMENT
• Microscopic /RDT and
Falciparum positive
Falciparum Malaria • If age < 12 mths, treat
with QUININE SULPHATE.
• If age > 12 mths, treat
with ACT (ARTEMISININ
COMBINATION THERAPY)
• Give one dose of
PARACETAMOL for fever
38 degree celcius or
above.
• Advise caregiver when to
return immediately.
• Follow up in 3days . If
fever persists everyday
then REFER for further
evaluation.
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22. SIGNS CLASSIFICATION TREATMENT
• Microscopic /RDT
positive and Falciparum
Negative
Malaria without falciparum
(vivax)
• Treat with CHOROQUINE
for vivax malaria.
• Give single dose of
PARACETAMOL for fever
38 degree celcius or
above
• Advise caregiver when to
return immediately.
• Follow up in 3days . If
fever persists everyday
then REFER for further
evaluation.
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23. SIGNS CLASSIFICATION TREATMENT
• Runny nose
OR,
• Measles
OR,
• Other causes of fever
AND
• Microscopic/RDT
Negative
Fever: no signs of malaria • Give single dose of
PARACETAMOL for fever
38 degree celcius or
above
• Advise caregiver when to
return immediately
• Follow up in 3days , if
fever persists everyday.
• If fever persists for more
than 7 days then REFER
for further evaluation.
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24. NO MALARIA RISK area
SIGNS CLASSIFICATION TREATMENT
• Any danger signs
OR,
• Stiff neck
High grade fever • Give first dose of
AMPICILLIN IM
• Prevent low blood sugar
• Give single dose of
PARACETAMOL if fever
38.5 degree celcius or
more.
• REFER urgently
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25. SIGNS CLASSIFICATION TREATMENT
• Any other cause of fever fever • Give single dose of
PARACETAMOL if fever
38.5 degree celsius or
more.
• Advise caregiver when to
return immediately
• Follow up in 3days , if
fever persists everyday.
• If fever persists for more
than 7 days then REFER
for further evaluation.
• Treat other cause of
fever.
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26. MALNUTRITION
■ Malnutrition refers to deficiencies or excesses in nutrient intake,
imbalance of essential nutrients or impaired nutrient utilization.
■ According to NDHS 2011, 11% of under 5 children are affected by
severe malnutrition, 41% are affected by stunting and 29% are
underweight.
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27. SIGNS CLASSIFICATION TREATMENT
• Visible weight loss
OR,
• Pitting oedema in both
feet OR,
• MUAC <11.5cm (red)
OR,
• Low weight for age (< -
3 SD)
Severe acute malnutrition • Give single dose of
vitamin A. In
kwashiorker, give
vitamin A after the
edema is subsided.
• REFER urgently
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28. SIGNS CLASSIFICATION TREATMENT
• MUAC 11.5-12.5cm
(Yellow) or,
• Low weight for age (< -2
to -3 SD)
Moderate Acute
malnutrition
• REFER URGENTLY if
develops any medical
complication
• Assess the child’s
feeding and counsel the
caregiver on the feeding
recommendations
• If any feeding problems,
follow up in 5 days.
• Advise when to return
immediately
• If low weight for age,
follow up in 30days.
• ALBENDAZOLE if child is
>1yr and is not given the
dose in previous 6mths.
• Vitamin A 28

29. SIGNS CLASSIFICATION TREATMENT
• MUAC 12.5cm or more
(Green) or,
• Average weight for age or
• Average weight for height
No malnutrition • Assess the child’s
feeding and counsel the
caregiver on the feeding
recommendations
• If any feeding problems,
follow up in 5 days for
observation.
• Advise caregiver when to
return immediately
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30. REFERENCES
■ Ghimire B. A textbook of Community Health Nursing. 7th ed. Kathmandu:
vidyarthi publication; 2018. P.246-54.
■ Shrestha T. Essential Child Health Nirsing. 2nd ed. Kathmandu: medhavi
publication; 2021. P.659-66.
■ CB-IMNCI booklet and app.
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